Provider Demographics
NPI:1114491800
Name:BROTHERS, JESSICA ROBERTS (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ROBERTS
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 ANSLEY CT
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2762
Mailing Address - Country:US
Mailing Address - Phone:770-241-1593
Mailing Address - Fax:
Practice Address - Street 1:1020 BARBER CREEK DR STE 213
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5984
Practice Address - Country:US
Practice Address - Phone:770-241-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional